The shortage of deceased donor organs compared to the number of patients on the waiting list for liver transplantation requires the use of other sources of grafts. The main hindrance in promoting living donor liver transplantation remains the morbi-mortality risk for the donor.
To reduce this risk, living donor liver preconditioning has been developed to improve the donor postoperative recovery. For example, in 2005, Malik et al. proposed the administration of thyroid hormones T3 to living donors. Accordingly, T3 doses were administered to rats ten days before hepatectomy and an increased total liver volume to body weight ratio was obtained—See “a study relevant to donor preconditioning”, Am J Transplant 2005; 5: 1801-1807. However, the administrated doses of T3 (2 mg/kg/day) were nearly 2000 times over the maximum administered dose in humans (2.5 lg/kg/day)—See Hamilton M. et al. “Safety and hemodynamic effects of intravenous triiodothyronine in advanced congestive heart failure”, Am J Cardiol 1998; 81: 443-447. Despite these interesting results in terms of liver regeneration, it seems difficult to apply this preconditioning to humans.
Portal vein embolization, as a starter of liver regeneration, has been disclosed, for instance, by Lesurtel M. et al. in “Temporary portal vein embolization as a starter of liver regeneration”, J Hepatol 2008; 49: 313-315. In such a technique, a lobar portal vein is occluded so as to induce the atrophy of the ipsilateral liver lobe and, thus, the hypertrophy of the contralateral liver lobe before surgical resection of the ipsilateral liver lobe. Nevertheless, the atrophic consequences of this technique on the ipsilateral liver lobe preclude using this lobe as a liver graft and, therefore, this technique cannot be used in liver preconditioning before liver transplantation.
Thus, there is a need for improved devices and methods for liver preconditioning before partial hepatectomy and, in particular, before liver transplantation.